DAVID STERN, MD (Practice Velocity) Q.Are you able to bill the following two codes together with a modifier: 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions) 17111 (15 or more lesions)? – Question submitted by Julie Briggs A.These are mutually exclusive codes. You can use 17110 if the physician destroys 14 or less benign lesions (usually warts). …
Read MoreCoding for Services Attempted But Not Completed, and Other Reader Queries
DAVID STERN, MD (Experity) Q.I can’t find any documentation that tells us specifically how we should code when a provider tries to remove a foreign body, but is not successful and decides that the patient should go to the ER. Do we just code for an office visit or do we also code for the removal of the foreign body since the provider did try, albeit unsuccessfully, and decided the patient needed to be seen …
Read MoreThe Finer Points in Determining New vs. Established Patients
DAVID STERN, MD (Practice Velocity) Q.Our urgent care practice serves a 70-physician primary care group. The UC uses the three-year rule; if the patient has been seen by any physician in the medical group within the last three years, he/she is an established patient even if the patient has never been previously seen in the urgent care. A comparable UC center in a nearby city applies the three-year rule differently; if the patient has been …
Read MoreReaders’ Coding Inquiries
DAVID STERN, MD (Practice Velocity) Q.How would you define the difference between an expanded problem-focused exam and the detailed exam in the 1995 evaluation and management coding guidelines? – Question submitted by Eddie Stahl, Medical Staff Director, Tennessee Urgent Care Associates A.For both the expanded problem-focused exam (EPF) and the detailed exam, the provider must document between two and seven body systems. The difference is that the EPF exam requires a “limited” exam of a …
Read MoreDeciphering Payor Language and Other Challenges
DAVID STERN, MD (Practice Velocity) Q.Many procedures, such as injections and fracture care, are reported to patients as “surgery.” Patients sometimes accuse us of false billing, as they don’t consider these procedures to be a “surgery.” How can we fix this problem? A.All third-party payors have installed computer software programs that have code descriptions loaded for each CPT code. Many of these code descriptions are hard to understand, and sometimes they are not truly accurate. CPT …
Read MoreFollow-up Questions Regarding Post – operative Care and ‘Established’ Patients
DAVID STERN, MD (Practice Velocity) Q.I was curious about your response to a case listed in Coding Q&A in the November issue of JUCM. The case described a patient who returned for reopening of a wound due to infection. The physician then cleansed and re-sutured the wound. Although I agree about the postoperative care in general, I wonder if modifier -79 would be appropriate in these circumstances. According to instructions by the AMA, this modifier …
Read MoreAddressing Problem-based Coding and Other Challenges
Q.We are a fairly new urgent care center and could use some help on E/M coding. I have read on various urgent care websites that we can bill each visit as a new patient visit (as long as it isn’t a follow-up to an existing problem). Can you please give me some direction on where I can find this information? A.What you are referring to is “problem-based coding.” Never code in this way unless you …
Read MoreProper Coding for Removal of Foreign Bodies
Q.Recently we removed a tampon that was retained for one week. What is the code for removing a foreign body from the vagina? A.Although this procedure involves significant work, and the resultant foul odor can leave an exam room unusable for hours, the procedure is considered to be a part of the E/M. Of course, this is hard to understand, since there is a code for removing a foreign body from the external ear canal …
Read MoreCoding for Removal of Impacted Cerumen (69210)
Q.What is the correct use of CPT code 69210 (removal impacted cerumen [separate procedure], one or both ears)? – Question submitted by Kathy Partenheimer, Medical of Dubois A.In the July 2005 issue of CPT Assistant, the AMA clearly indicates that you should report 69210 onlywhen the following two criteria are both met: “the patient had cerumen impaction” “the removal required physician work using at least an otoscope and instrumentation rather than simple lavage” [emphasis added]. …
Read MoreInjection Procedures and E/M Codes
DAVID STERN, MD (Practice Velocity) Q.Can we bill an evaluation and management code along with the code for administration of an intravenous injection? A.Although it may seem obvious to expect reimbursement in these situations, Medicare waited until 2006 to begin reimbursing physicians for a separate E/M (99201- 99205, 99212-99215) when performed at the same time as IV drug administration. The Medicare Claims Processing Manual states, “Medicare will pay for medically necessary office/outpatient visits billed on …
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